Gender Disparities in Pain and Treatment and their Association with Alzheimer's Disease and Related Dementias (ADRD)

项目摘要/摘要 我是老年医学和姑息医学部内科助理教授， 在德克萨斯大学医学分校。我的长期职业目标是成为一名独立研究员 世卫组织确定阿尔茨海默氏症老年患者健康方面性别差异的驱动因素和后果 疾病和相关痴呆(ADRD)，将生命过程、社会和健康结构与临床细节相结合 从医疗索赔。为了实现这一目标，我将完成以下四个以此为基础的培训目标 我之前接受的老龄化流行病学培训：(1)了解影响疼痛和ADRD的复杂过程 在老年人中；(2)学习性/性别的背景以及按性别和性别分析结果的技巧，与 关注疼痛和ADRD的性别和性别差异；(3)发展分析医疗保险的统计技能 与调查数据相关联的索赔数据；以及(4)提高作为 独立的外部资助的调查员，通过发展指导和领导技能并加强 手稿和拨款申请，以及领导技能。这些领域的培训将包括课程作业， 在临床环境中跟踪跨学科团队，以及访问、管理和分析的经验 医疗保险档案。我的培训活动已经与一个研究项目相结合，在该项目中，我将使用来自 健康和退休研究是一项具有全国代表性的对美国老年人的纵向研究，它将 到医疗保险报销(2006-2018年)，以完成以下具体目标：(A)评估性别差异 通过将调查数据中的疼痛自我报告与慢性疼痛的诊断进行比较，对疼痛诊断不足 老年人的索赔数据，按ADRD状况分列；(B)检查慢性疼痛治疗中的性别差异 在有疼痛的老年人中，按ADRD状况分类；以及(C)评估与慢性精神分裂症相关的性别差异 使用ADRD事件进行疼痛和疼痛治疗。这项研究的预期结果将为 疼痛和疼痛治疗是ADRD的一个可改变的危险因素，并为潜在的疼痛治疗干预提供信息 旨在缩小男女之间的治疗差距，并最终缩小#年的性别差距 ADRD负担。K01导师培训和研究计划的完成将为我提供知识， 了解患有ADRD的老年人之间的差异所需的技能和专业知识，以便制定 将生命过程、社会和健康结构与临床数据相结合的研究计划，目标是 减少患有疼痛和ADRD的老年人中的性别差异。

PROJECT SUMMARY/ABSTRACT I am an Assistant Professor in the Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, at the University of Texas Medical Branch. My long term-career goal is to become an independent researcher who identifies drivers and consequences of gender disparities in health among older adults with Alzheimer’s disease and related dementias (ADRD), blending life course social and health constructs with clinical details from medical claims. To accomplish this goal, I will complete the following four training objectives that build upon my prior training in the epidemiology of aging: (1) Understand the complex processes that impact pain and ADRD among older adults; (2) Learn context of sex/gender and techniques to analyze results by sex and gender, with a focus on sex and gender differences in pain and ADRD; (3) Develop statistical skills for analyzing Medicare claims data linked to survey data; and (4) Increase competencies required to function effectively as an independent extramurally-funded investigator, by developing mentoring and leadership skills and enhancing manuscript and, grant applications, and leadership skills. Training in these areas will include coursework, shadowing interdisciplinary teams in clinical settings, and experiences accessing, managing, and analyzing Medicare files. My training activities have been integrated with a research project in which I will use data from the Health and Retirement Study, a nationally representative longitudinal study of older adults in the US, linked to Medicare claims (2006-2018) to complete the following specific aims: (A) Evaluate gender differences in the underdiagnosis of pain by comparing self-reports of pain from survey data to the diagnosis of chronic pain from claims data in older adults, by ADRD status; (B) Examine gender disparities in the treatment of chronic pain among older adults with pain, by ADRD status; and (C) Assess gender disparities in the association of chronic pain and pain treatment with incident ADRD. The expected findings of this research will provide evidence for pain and pain treatment as a modifiable risk factor for ADRD and inform potential pain treatment interventions aimed at reducing the treatment gap between men and women and ultimately reducing the gender disparity in ADRD burden. Completion of the K01 mentored training and research plans will provide me with the knowledge, skills, and expertise required to understand disparities among older adults with ADRD, in order to develop a program of research that blends life course social and health constructs with clinical data, with the goal of reducing gender disparities among older adults with pain and ADRD.